Healthcare Policy

TIME’S UP announced today the launch of TIME’S UP Healthcare, a new affiliate which aims to drive new policies and decisions that result in more balanced, diverse and accountable leadership; address workplace discrimination, harassment and abuse; and create equitable and safe work cultures within all facets of the healthcare industry. TIME’S UP Healthcare is the newest industry affiliate of TIME’S UP, joining a coalition of women across industries dedicated to advancing the organization’s mission of creating safe, fair and dignified work for women of all kinds.

Show Me Your Stethoscope, through our STAMP Out Violence campaign, has striven to raise awareness to the epidemic of violence and harassment that Nurses endure everyday while on the job and has stood by our colleagues, helping to amplify the voice of a Nation of Nurses. We work to address a workplace culture that has come to expect that Nurses will be abused, encouraging all people to speak up and report incidents of physical, verbal and sexual assault. Show Me Your Stethoscope is proud to support TIME’S UP Healthcare’s goal “To unify national efforts to bring safety, equity, and dignity to our healthcare workplace.”

SMYS’ Kelley Muldoon-Rieger MSN PNP and Julia Sierra-Sanchez will be on hand and speaking at the March 1 launch of TIME’S UP Healthcare.

I sit in my car after a nursing shift. Drained. Again.
Numb but frazzled. Again.
Feeling that sick anxious worry in the pit of my stomach. Again.
I had 6 very sick patients to care for on my shift- too many. Again.
I anxiously review the shift in my mind, questioning. “Did I do enough?”

I did the best I could. I gave everything I had. I didn’t eat, I didn’t even pee.

“But was it enough? Could I have done more? Could I have saved that one patient/not let that patient die alone/been a better nurse/done better”?

I wish the answer was “Yes. My patients received the best care they could.”
But after this shift, my gut and my heart tell me the answer is “No”. Again.

If only I had less patients, a safer level of patients, maybe I could have.

Maybe my first patient wouldn’t have fallen and broken her hip because I would have been there to help her get out of bed.
Maybe Patient #2 wouldn’t have suffered in pain for so long because medications were delayed while we were coding my 3rd patient.
Maybe I would have caught patient #4’s fever earlier, before they became septic and had to be transferred to the ICU.
Maybe I could have comforted the daughter of patient #5 who was just told there was nothing more we could do.
Maybe patient #6 wouldn’t have died, in the dark, afraid, in pain and alone because I was dealing with emergencies with patients 1-5.
These patients were someone’s mom, dad, child.
Maybe if I had a safer number of patients to care for, I could have saved just 1.

This is the norm, rather than the exception for nurses.
No matter how good of a nurse I am, taking care of too many patients is unsafe. Impossible, unfair to patients and nurses. People are dying unnecessarily, or developing complications that could have been avoided.

The evidence is clear. Studies show that there is a “safe” number of patients to care for, and an “unsafe “number of patients to care for.* For every patient over 4 that a nurse cares for on a Med/Surg floor, there is a 7% increased risk of death for her patients. If a nurse cares for 6 patients, that means there is a 14% increased risk of death. 7 patients =21% increase. Not just risk of a complication or a mistake- DEATH.

How would you feel if that was your mom. Your child. Your brother. How many patients do you want their nurse to be taking care of? And why would hospitals staff nurses at levels that put patients at an increased risk for dying?

In Massachusetts, voters will have the chance to save lives. Issue 1, written by nurses, would limit the number of patients that a nurse can care for, based on the the most recent studies that show how many patients are safe.

Opponents of Issue 1 instill fear about the implications of the bill- “there won’t be enough nurses”, “hospitals will close”, “NICU units will shut down” “You will be turned away at the ER” “ER wait times would increase dramatically”

I wish we could see what it would look like 10 years, 15 years later after we passed Issue 1- what would it look like? Would all of these fears come to pass?

Guess what- we can.

California, the only state to have nurse patient limits, passed a nearly identical law in 1999. I went to California and interviewed nurses in Los Angeles and San Francisco from a variety of hospitals and asked them about what it was like before and after their law passed.

They responded with nearly identical responses:
-Hospitals are making more money than ever.
-Not one hospital has closed, even smaller community hospitals
-Nurses are coming back to the bedside to work- they have less stress, less burnout
-Patients are getting better care- they have less infections, less readmission rates
-No units have closed
-Support staff have not been eliminated
-ER wait times? California has some of the lowest ER wait times in the country. Patients aren’t turned away.
-LESS PATIENTS ARE DYING

In fact, most nurses looked at me like I was crazy to even ask those questions. I said “that’s what they are telling Massachusetts nurses”. “Nope” they replied, “we love our patient limit legislation”. They couldn’t even imagine working without these limits. Even nurse managers and hospital administrators had positive stories about the nurse patient limits legislation.
So why are hospitals staffing nurses at an unsafe level? Why are there 2 standards of care? Is it costs? How much is your loved one’s life worth?

Which hospital would you send your mom, or your child to? A California hospital with research based safe patient limit laws. Or a hospital in a state like Massachusetts, without safe patient limits, where nurses may have 7 patients or more, giving your mother, your loved one a 21% higher risk of dying. A hospital where patients have a greater risk of complications, of being in untreated pain, of dying alone, in the dark, in pain and in fear.

SMYS members, please reach out to family, friends, colleagues in Massachusetts and let them know how important Issue 1 is for patients. Patients deserve better. Bedside nurses, just like you, just like the nurses who wrote this bill, tell us every day, over and over that safe patient limits are needed. They never want to think to themselves after a shift- if only I could have saved just 1 by having a safer patient load. They worry for their patients, their loved ones, your loved ones.

This year more nursing unions joined with their brothers and sisters at NursesTakeDC, the frontline nurse led grassroots movement fighting for safe staffing. The Massachusetts Nurses Association (MNA) was one of the unions rallying in DC and deserves special recognition. Specifically, we’d like to acknowledge MNA president Donna Kelley Williams RN for her tenacious leadership and advocacy in Massachusetts. The MNA leads the fight for ‘safe patient limits’’; a term they developed that perfectly describes what we are fighting for.

Thanks to the tireless push from the MNA, Massachusetts voters will have a ballot question this November 2018 that decides if ‘safe patient limits’ will be written into state law. Nurses overwhelmingly support safe patient limits. However, the voters of Massachusetts will determine if this becomes a law or not. So far the polls suggest that voters will choose ‘yes’ to safe patient limits, but the fight isn’t over yet!

Massachusetts policy is often viewed as forecast of future national policy. This ballot question is monumental as several states have legislation that has been introduced but has yet to reach committee or the house floor for a vote. A win for Massachusetts nurses could tip the scales in the favor of nurses.

We’ve watched the MNA support the nurses of Massachusetts in their fight for safe patient limits. Now it’s time to do more that watch them work. Now we must support the nurses of Massachusetts in their push for safe patient limits in Massachusetts. We must gain public support and momentum to vote ‘yes’ on this ballot question. At SMYS we believe nurses should support nurses; nursing organizations should support each other; and all nurses in all settings, practicing at all levels should support policy that benefits nurses. Leading up to the November vote, we encourage every nurse to support the nurses of Massachusetts in any way they can.

Social media is a powerful tool. Every nurse can help this cause by sharing information about the ballot question online via Facebook, Twitter, Instagram, and LinkedIn. If you live in Massachusetts or one of the neighboring states (Main, New Hampshire, Vermont, Connecticut, New York, Rhode Island), please consider showing up in person to support the Massachusetts nurses. A win for safe patient limits in Massachusetts is a win for all nurses and patients.

In 2008 both South Korea and China declared that gaming addiction was their number one public health problem. Today, these countries have sixteen treatment centers, a school internet screening tool, two week detox program and over 5000 counselors trained in internet addiction. In contrast, the CDC does not list internet addiction as even one of its top ten public health concerns – despite the fact that the screen time for America’s youth is over 7 hours a day, and that our children today only spend 4 to 7 minutes a day outdoors.

As a country we have failed to adequately acknowledge this crises as well as the impact it will ultimately have on our society. Most people do not even know that gaming in excess causes physical changes to the brain’s very structure at a time when it is still evolving. According to Dr. Hillarie Cash, founding member of ReStart Life, the signs and symptoms of addiction are:

Attention, learning and self-control problems

Impaired social skills

Emotional problems, anxiety, low self-esteem and depression

Aggression and indifference to human pain

Physical problems – eye strain, weakness, carpal tunnel

Strong correlation with sex and porn

Concerned, I paid a visit to the first digital addiction treatment center in the nation. Dr. Hillarie Cash gave me a tour of the group treatment center at ReStART, but most enlightening were the personal conversations with the residents themselves who could barely make eye contact with me. Emphatically, these young men relayed what parents should NOT do:

Don’t tell kids its bad – tell them and show them the impact gaming has on their lives

Don’t get help until children admit there is a problem (it’s usually an event)

Don’t act like being on the internet is a reward

Don’t say “as long as you do what you are supposed to do (like good grades) then I don’t care

What should parents do? Unanimously these men wished that their parents had put parental controls on with explanations about the power of digital addiction – and they also wanted their parents to sit down and eat dinner with them. Real human connection appears to be a good antidote.

Pass this information along. Educate yourself on the powerful pull of digital media. Bring up the subject in PTA meetings, churches and social gatherings to help raise awareness in our society of the insidious damage of digital media addiction and inform your loved ones- in person! Or maybe download the APP “Moment” to monitor your own screen time (a reality check for my husband and I). As adults, set a good example. Over 60% of adults sleep with their cell phones at night, and half of adults read their emails during the night.

There has been a two year waiting list for ReStart Life for quite a while now – which clearly demonstrates the need. We may be late to the game, but there is still time for us to rally together to preserve the personal connections that make us human, and to protect our children from danger that they cannot see.

This is the first guest blog in a series by Kathleen Bartholomew, author of The Dauntless Nurse. Don’t forget to read her second post in the series “It all comes back to staffing“

There -are now 28 states that have approved the use of medical marijuana – and 8 states recreationally. So chances are strong that some nurses are using marijuana for medical reasons, or for recreation. But how much is too much?

One joint in the 1970’s has the same potency of one puff today. Since 1998 the potency of marijuana has doubled. But what if you smoke a few hours before your shift? Edibles can take a few hours to feel the effects – and if you smoke it can take three hours or more to get out of your system. Having a medical-use card does not give nurses sufficient protection, as discussed this Medscape article.

Nurse Mary has lupus and a medical marijuana card. She also wants to make sure she is safe taking care of her patients; and that her license is safe. The laws don’t prohibit use unless it impairs practice, but employers can still take action. So both of these areas are still gray zones as marijuana is not supported federally, there is no consensus on toxicity level, and a hospital can decide independently to fire someone who tests positive whether they have a card or not. In Washington State for example, driving under the influence of marijuana is similar to driving drunk: 0.8 for alcohol – or 5ng/ml THC. But do you know your THC level when you arrive at work?

“If you consistently notice any of the problems listed below in a peer, it is your ethical obligation to compassionately go to your peer, and share your concerns. Our primary obligation as nurses is to protect our patients, but we should also care for each other. A large percentage of nurses are over the age of 45, so some of the symptoms below may be related to menopause! We shouldn’t jump to conclusions or make judgments, but most importantly we can’t ignore impaired nurses.

How would you handle a situation with a nurse that appeared to be impaired?

What would you do if a nurse had symptoms of being impaired by marijuana such as: